产后发生创伤后应激障碍的危险因素与助产干预效果研究

Study on risk factors of postpartum post-traumatic stress disorder and the intervention effects of midwifery

目的分析产后发生创伤后应激障碍(PPTSD)的危险因素,并探讨助产干预在预防PPTSD中的效果。方法选取2017年1月至2019年12月收治的顺产产妇382例作为研究对象,根据产后42 d内是否发生PPTSD,将产妇分为PPTSD组和NON-PPTSD组。收集所有产妇一般资料、临床资料,应用Logistic回归,分析产妇发生PPTSD的危险因素。根据危险因素制定助产干预措施,选取2020年1至12月收治的顺产产妇106例作为研究对象,根据随机数字表,将产妇分为干预组和对照组,每组53例,观察2组产妇产后42 d内PPTSD发生情况。结果382例产妇中,有46例在产后42 d内发生PPTSD,发生率12.04%。二元Logistic回归分析显示,3年内发生过创伤性事件(OR:7.759,95%CI:3.391~17.754)、产程延长(OR:6.805,95%CI:2.022~22.897)、存在新生儿并发症(OR:5.196,95%CI:2.072~13.030)是产妇发生PPTSD的独立危险因素(P<0.05)。根据危险因素制定助产干预措施后,53例产妇中,发生PPTSD1例,发生率1.89%,低于对照组的13.21%,差异有统计学意义(P<0.05)。结论3年内发生过创伤性事件、产程延长、存在新生儿并发症是产妇发生PPTSD的独立危险因素,针对上诉危险因素制定助产干预措施,可有效降低PTTSD的发生几率。

Objective To investigate the risk factors of postpartum post-traumatic stress disorder(PPTSD)and the intervention effects of midwifery in the prevention of PPTSD.Methods A total of 382 pregnant women who underwent spontaneous delivery in our hospital from January 2017 to December 2019 were enrolled in the study,who were divided into PPTSD group and NON-PPTSD group according to whether PPTSD occurred within 42 days after childbirth.The general data and clinical data were collected,and Logistic regression was used to analyze the risk factors of PPTSD.According to the risk factors,the midwifery intervention measures were made.Moreover the other 106 pregnant women who underwent spontaneous delivery in our hospital from January 2020 to December 2020 were enrolled as research subjects,who were randomly divided into intervention groups and the control group,with 53 cases in each group.The incidence of PPTSD within 42 days after delivery was observed.Results Of the 382 pregnant women,46 cases had PPTSD within 42 days after delivery,with the incidence of PPTSD being 12.04%.Binary logistic regression analysis showed that traumatic events occurred within 3 years,delivery delayed,neonatal complications were independent risk factors affecting the occurrence of PPTSD(P<0.05).After the midwifery intervention,of the 53 pregnant women,one case had PPTSD,with the incidence of PPTSD being 1.89%,which was significantly lower than that(13.21%)in control group(P<0.05).Conclusion The traumatic events occurred within 3 years,delivery delayed,neonatal complications are the independent risk factors affecting the occurrence of PPTSD,and to institute the midwifery intervention measures targeting for the risk factors can effectively decrease the incidence of PTTSD.